|
Special Care Observation Per Hour
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040437
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Special Dosimetry
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
3040385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$685.40 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$558.75
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Special Dosimetry
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
3040385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$365.05 |
| Max. Negotiated Rate |
$685.40 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$447.00
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Special Dosimetry 7733126
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 77331 26
|
| Hospital Charge Code |
5258633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$276.45 |
| Rate for Payer: Aetna Commercial |
$276.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$276.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Health EOS Commercial |
$264.81
|
| Rate for Payer: HFN Commercial |
$276.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.37
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$276.45
|
| Rate for Payer: Quartz Beloit One Network |
$128.04
|
| Rate for Payer: Quartz Commercial |
$165.87
|
| Rate for Payer: The Alliance Commercial |
$145.50
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
Special Ophthalmolgical Services: Biometry With IOL Calculation
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
1188927
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$186.74 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.80
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: HFN Commercial |
$116.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.74
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: The Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Medicaid |
$74.20
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Special Ophthalmolgical Services: Corneal Topography With Interpretation
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
1188931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.92 |
| Max. Negotiated Rate |
$125.07 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.80
|
| Rate for Payer: Health EOS Commercial |
$52.78
|
| Rate for Payer: HFN Commercial |
$55.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.07
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55.10
|
| Rate for Payer: Quartz Beloit One Network |
$25.52
|
| Rate for Payer: Quartz Commercial |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$29.00
|
| Rate for Payer: United Healthcare Medicaid |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Special Ophthalmolgical Services: Fluorescein Angiography With Interpretation
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
1188929
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.45 |
| Max. Negotiated Rate |
$400.58 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$380.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.60
|
| Rate for Payer: Health EOS Commercial |
$364.91
|
| Rate for Payer: HFN Commercial |
$380.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$400.58
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$380.95
|
| Rate for Payer: Quartz Beloit One Network |
$176.44
|
| Rate for Payer: Quartz Commercial |
$228.57
|
| Rate for Payer: The Alliance Commercial |
$200.50
|
| Rate for Payer: United Healthcare Medicaid |
$108.45
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
Special Ophthalmolgical Services: Fundus Photography With Interpretation
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
1188928
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$133.54 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.00
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: HFN Commercial |
$95.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.54
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: The Alliance Commercial |
$50.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.91
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Special Ophthalmolgic Services: Extended Exam
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 92083
|
| Hospital Charge Code |
1188925
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$215.47 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.20
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: HFN Commercial |
$153.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.47
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: The Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Medicaid |
$29.93
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Special Ophthalmological Services: Determination of Refractive State
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 92015
|
| Hospital Charge Code |
2634799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$66.82 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Anthem Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.82
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: United Healthcare Medicaid |
$9.97
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Special Ophthalmological Services: Gonioscopy
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 92020
|
| Hospital Charge Code |
1188890
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.45 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$131.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$125.58
|
| Rate for Payer: HFN Commercial |
$131.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.32
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$131.10
|
| Rate for Payer: Quartz Beloit One Network |
$60.72
|
| Rate for Payer: Quartz Commercial |
$78.66
|
| Rate for Payer: The Alliance Commercial |
$69.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.45
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Special Ophthalmological Services: Sensorimotor Examination
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 92060
|
| Hospital Charge Code |
1188891
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$216.85 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.00
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: HFN Commercial |
$80.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$216.85
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: The Alliance Commercial |
$42.50
|
| Rate for Payer: United Healthcare Medicaid |
$47.82
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Special Ophth Services Sensorimotor Exam 9206026
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 92060 26
|
| Hospital Charge Code |
4605871
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$128.28 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.40
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: HFN Commercial |
$79.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Special Physics Consultation
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
3040393
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$755.58 |
| Max. Negotiated Rate |
$1,418.64 |
| Rate for Payer: Aetna Commercial |
$1,387.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.26
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$1,418.64
|
| Rate for Payer: Health EOS Commercial |
$1,372.38
|
| Rate for Payer: HFN Commercial |
$1,418.64
|
| Rate for Payer: Multiplan Commercial |
$1,233.60
|
| Rate for Payer: NAPHCARE Commercial |
$925.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.64
|
| Rate for Payer: Quartz Beloit One Network |
$755.58
|
| Rate for Payer: Quartz Commercial |
$925.20
|
| Rate for Payer: WEA Trust Commercial |
$848.10
|
| Rate for Payer: WPS Commercial |
$1,142.16
|
|
|
Special Physics Consultation
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
3040393
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$1,418.64 |
| Rate for Payer: Aetna Commercial |
$1,387.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.12
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$1,418.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$862.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$1,372.38
|
| Rate for Payer: HFN Commercial |
$1,418.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$1,233.60
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.64
|
| Rate for Payer: Quartz Beloit One Network |
$755.58
|
| Rate for Payer: Quartz Commercial |
$1,002.30
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$1,156.50
|
| Rate for Payer: WEA Trust Commercial |
$848.10
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$1,142.16
|
|
|
Special Stain For inclusion Bodies Or Parasites
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
1188853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$131.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$125.58
|
| Rate for Payer: HFN Commercial |
$131.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.14
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$131.10
|
| Rate for Payer: Quartz Beloit One Network |
$60.72
|
| Rate for Payer: Quartz Commercial |
$78.66
|
| Rate for Payer: The Alliance Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Special Stains 1
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$241.84 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$162.75
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Special Stains 1
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Special Stains 1
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$271.63 |
| Rate for Payer: Aetna Commercial |
$206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Anthem Commercial |
$11.03
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$206.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.20
|
| Rate for Payer: Health EOS Commercial |
$197.47
|
| Rate for Payer: HFN Commercial |
$206.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.63
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$206.15
|
| Rate for Payer: Quartz Beloit One Network |
$95.48
|
| Rate for Payer: Quartz Commercial |
$123.69
|
| Rate for Payer: The Alliance Commercial |
$108.50
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Special Stains 2
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$271.63 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Anthem Commercial |
$11.03
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: HFN Commercial |
$46.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.63
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: The Alliance Commercial |
$24.50
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Special Stains 2
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$241.84 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.36
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Special Stains 2
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
2778830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Special Treatment Procedure
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
3040409
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$690.41 |
| Max. Negotiated Rate |
$1,296.28 |
| Rate for Payer: Aetna Commercial |
$1,268.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.77
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,296.28
|
| Rate for Payer: Health EOS Commercial |
$1,254.01
|
| Rate for Payer: HFN Commercial |
$1,296.28
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$845.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.28
|
| Rate for Payer: Quartz Beloit One Network |
$690.41
|
| Rate for Payer: Quartz Commercial |
$845.40
|
| Rate for Payer: WEA Trust Commercial |
$774.95
|
| Rate for Payer: WPS Commercial |
$1,043.65
|
|
|
Special Treatment Procedure
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
3040409
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$581.84 |
| Max. Negotiated Rate |
$2,327.36 |
| Rate for Payer: Aetna Commercial |
$1,268.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.74
|
| Rate for Payer: Aetna Managed Medicare |
$581.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,745.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.24
|
| Rate for Payer: Anthem Medicare Advantage |
$581.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.84
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cash Price |
$422.70
|
| Rate for Payer: Cigna Commercial |
$1,296.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$581.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$581.84
|
| Rate for Payer: Health EOS Commercial |
$1,254.01
|
| Rate for Payer: HFN Commercial |
$1,296.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,164.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$581.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$581.84
|
| Rate for Payer: Multiplan Commercial |
$1,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,296.28
|
| Rate for Payer: Quartz Beloit One Network |
$690.41
|
| Rate for Payer: Quartz Commercial |
$915.85
|
| Rate for Payer: Quartz Medicare Advantage |
$581.84
|
| Rate for Payer: The Alliance Commercial |
$2,327.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.84
|
| Rate for Payer: United Healthcare PPO |
$1,056.75
|
| Rate for Payer: WEA Trust Commercial |
$774.95
|
| Rate for Payer: Wellcare Medicare |
$581.84
|
| Rate for Payer: WPS Commercial |
$1,043.65
|
|
|
Special Treatment Procedure 77470
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
CPT 77470
|
| Hospital Charge Code |
5516739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$479.75 |
| Rate for Payer: Aetna Commercial |
$479.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.30
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$479.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.00
|
| Rate for Payer: Health EOS Commercial |
$459.55
|
| Rate for Payer: HFN Commercial |
$479.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.42
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$479.75
|
| Rate for Payer: Quartz Beloit One Network |
$222.20
|
| Rate for Payer: Quartz Commercial |
$287.85
|
| Rate for Payer: The Alliance Commercial |
$252.50
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
